Acute dizziness and mental alteration associated with Moderna COVID-19 vaccine: a case report.

BACKGROUND: Due to a rising number of COVID-19 cases, the Indonesian government implemented public health programs to lower the rate. Since January 2021, one of the government's primary policies has been the COVID-19 immunization program. Recently, the Moderna messenger ribonucleic acid (mRNA) vaccine is one of the COVID-19 vaccines used in Indonesia. Based on some research, Moderna has possible side effects throughout the body, including neurological symptoms. CASE PRESENTATION: We describe a 39-year-old female with uncontrolled hypertension who showed behavioral change, communication difficulty, social withdrawal, and a confused state within 7 days from getting her first dose of the Moderna vaccine. The patient had a history of febrile convulsion in childhood. An increase of neutrophil-to-lymphocyte ratio (16.9) and C-reactive protein level (31.75 mg/L) indicates ongoing inflammation. Head CT scan shows no abnormalities. She received ceftriaxone, citicoline, and methylprednisolone. The patient was discharged on the seventh day and completely recovered 1 week later. This study is the first case report of encephalopathy following the administration of the Moderna COVID-19 vaccine reported in Indonesia up to our knowledge. CONCLUSION: Encephalopathy related to the Moderna COVID-19 vaccine should be acknowledged as an adverse effect of the Moderna COVID-19 vaccine.

Corrigendum: The role of homocysteine levels as a risk factor of ischemic stroke events: a systematic review and meta-analysis.

[This corrects the article DOI: 10.3389/fneur.2023.1144584.].

Medical comorbidities as predictors of COVID-19 short-term mortality: A historical cohort study in Indonesia.

Objectives: In this study, we aimed to evaluate the relation of comorbidities to coronavirus disease 2019 (COVID-19) short-term mortality. Materials and Methods: This was a single-center observational study with a historical cohort method at Bethesda Hospital Yogyakarta, Indonesia. COVID-19 diagnosis was made using reverse transcriptase-polymerase chain reaction on nasopharyngeal swabs. Patient data were obtained from digital medical records and used for Charlson Comorbidity Index assessments. Inhospital mortality was monitored throughout their hospital stay. Results: This study enrolled 333 patients. According to the total number of comorbidities in Charlson, 11.7% (n = 39) of patients had no comorbidities; 30.9% (n = 103) of patients had one comorbidity; 20.1% (n = 67) of patients had two comorbidities; and 37.2% (n = 124) of patients had more than three comorbidities. In multivariate analysis, these variables were significantly related to short-term mortality in COVID-19 patients: older age (odds ratio [OR] per year: 1.64; 95% confidence interval [CI]: 1.23-2.19; P 0.001), myocardial infarction (OR: 3.57; 95% CI: 1.49-8.56; P: 0.004), diabetes mellitus (OR: 2.41; 95 CI: 1.17-4.97; P: 0.017), renal disease (OR: 5.18; 95% CI: 2.07-12.97; P < 0.001), and longer duration of stay (OR: 1.20; 95% CI: 1.08-1.32; P < 0.001). Conclusion: This study revealed multiple short-term mortality predictors in COVID-19 patients. The coexistence of cardiovascular disease, diabetes, and renal problem is a significant predictor of short-term mortality in COVID-19 patients.

Hydrocephalus Caused by Tuberculous Meningitis in an Immunocompetent Young Adult: A Case Report.

Background: Despite improved medical management, meningeal tuberculosis mortality and other outcomes have changed slightly over time due to a delay in diagnosis and treatment. This study reports a rare case of tuberculous meningitis in an immunocompetent host, calling into question the commonly held belief that tuberculous meningitis is a disease of immunocompromised individuals. Case Presentation: A 26-year-old male with no significant past medical history, tuberculosis, or indications of immunological compromise, was admitted to our hospital with a fever and altered mental status. He was drowsy, febrile (temperature of 38°C), had a heart rate of 110 beats per minute, and showed mild neck stiffness but no meningeal sign. A lumbar puncture on the third day of admission suggested tuberculous meningitis. He was treated for tuberculosis meningitis, and his condition slightly improved. However, the patient's condition suddenly worsened, and a repeat contrast computed tomography (CT) of the brain showed the development of ventriculomegaly and basilar enhancement. Insertion of an emergency ventriculoperitoneal shunt was performed; however, the patient died ten days after hospital admission. Conclusion: We report a fatal case of tuberculous meningitis in an immunocompetent patient. Healthcare practitioners must be trained to identify and diagnose tuberculous meningitis promptly. Early treatment of tuberculous meningitis based on clinical diagnosis and symptoms improves clinical outcomes.

The role of homocysteine levels as a risk factor of ischemic stroke events: a systematic review and meta-analysis.

Introduction: Among numerous risk factors, homocysteine (Hcy) has been linked to cerebral infarction; however, results have been inconsistent. This review aimed to conduct a meta-analysis of published studies to investigate the relationship between plasma Hcy levels and the risk of ischemic stroke. Methods: A systematic literature search was conducted until November 2022 to obtain articles reporting Hcy levels in ischemic stroke patients. Review Manager software was used to perform all statistical analyses (version 5.3). Results: Initial investigation yielded 283 articles. The final evaluation included 21 articles, including two prospective studies, one retrospective cohort, and 18 case-control studies. These studies included 9888 participants, of which 5031 were admitted patients with ischemic stroke. An integrated analysis revealed that ischemic stroke patients had significantly higher levels of Hcy than controls (mean difference (MD) = +3.70, 95% confidence interval (CI) = 2.42-5.81, p < 0.001). Conclusion: This meta-analysis and systematic review indicate that ischemic stroke patients have significantly higher homocysteine levels than controls. Detecting hyperhomocysteinemia and reducing homocysteine levels should be explored among individuals at increased risk for ischemic stroke.

Isolated Abducens Nerve Palsy After Herpes Zoster Ophthalmicus: A Case Report.

Aim: The purpose of this study was to demonstrate a case of herpes zoster in the patient. Methods: Case report. Results: Herpes zoster ophthalmicus is a rare but well-known cause of CN VI palsy that affects an elderly patient due to a reduction in the immunity to the Varicella Zoster Virus (VZV). We reported a case of herpes zoster in our patient, a 67-year-old Javanese female who presented with a VI nerve palsy within 1 week after the vesicular rash. Our patient received Valacyclovir, Gabapentin, and steroid treatment, then responded quite well to the combination of these therapies without side effects as the goals were to diminish acute and chronic pain, fasten the healing of the skin and nerve, and reduce the chances of dissemination. Based on studies, systemic antivirals should be given in all cases of HZO to minimize complications and steroids should not be given without antiviral therapy so as not to increase viral replication. Conclusions: As a complication of HZO, ophthalmoplegia may have various origins. We reported a case of sixth nerve palsy in HZO. Abbreviations: HZO = herpes zoster ophthalmicus, VZV = varicella-zoster virus, CN = Cranial Nerve.

Ischemic Stroke Following Calloselasma rhodostoma Snakebite: A Rare Case Report.

BACKGROUND: Ischemic stroke following a snakebite is a rare case. Snake venom consists of multiple components which can cause various symptoms and consequences. We report a case of ischemic stroke following Calloselasma rhodostoma snakebite, and this study was the first to report a case of ischemic stroke after snakebite in Indonesia. CASE PRESENTATION: A 72-year-old Mongoloid male presented with a history of snakebite one day before hospital admission with a swollen right lower leg with no history of hypertension, diabetes mellitus, or heart disease. The patient was conscious. His temperature was 36.5°C, pulse rate was 90 beats per minute, respiration rate was 30 breaths per minute, and blood pressure was 162/109 mmHg. The neurological examination showed left-side weakness and headache, with blood laboratory results showing prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT), leucocytosis, thrombocytopenia, and low haemoglobin. A computerized tomogram (CT) scan of the brain was taken, which revealed a sign of infarct in the pericallosal of the right lateral periventricular anterior horn. CONCLUSION: Although ischemic stroke following a snakebite is uncommon, it must be considered and monitored.

Persistent neurological manifestations in long COVID-19 syndrome: A systematic review and meta-analysis.

BACKGROUND: Several studies have reported prolonged symptoms especially neurological symptoms following acute infection in patients with COVID-19, known as long COVID-19. There are only few studies investigating this population and relatively less known, including nervous system involvement. A systematic review and meta-analysis of these studies are required to understanding the prevalence of persistent neurological manifestations after COVID-19. OBJECTIVE: To conduct a systematic review and meta-analysis on the persistent neurological manifestations in COVID-19 survivors. METHODS: Authors conducted a literature search through PubMed and MedRxiv from January 1st, 2020 to October 2021 according to PRISMA guideline. Furthermore, the authors added additional sources by reviewing related references. Studies presenting the neurologic features of long COVID-19 patients in their data were included. Case reports and case series also included in this review. The quality of the studies was assessed based on the Oxford Centre for Evidence-Based Medicine guidelines. Selected studies were included in the meta-analysis of proportion and heterogeneity test. FINDINGS: From 128 identified studies, 36 were eligible, with 9944 participants included. Most of the included studies had mean duration of follow-up after COVID-19 onset of less than 6 months. Fatigue was the most common (52.8%, 95%CI 19.9 - 84.4) symptoms of long COVID, followed by cognitive disorder (35.4%, 95%CI 2.1 - 81.7); paresthesia (33.3%, 95%CI 2.7 - 76.6); sleep disorder (32.9%, 95%CI 6.5 - 67.4); musculoskeletal pain (27.8%, 95%CI 12.7 - 46); and dizziness (26.4%, 95%CI 4.6 - 57.9). CONCLUSION: Neurological manifestations are prevalent and persisting in patients with long COVID. The duration of the symptoms are vary among literatures. However, the frequency are mostly observed during the first six months after the illness onset.

Bridging the gap of knowledge and skills for diagnosis and treatment of painful neuropathy: Development and evaluation of pain education project for clinicians in primary care settings.

The importance of pain education is widely accepted and recognized. This is a key part of educating the undergraduate and postgraduate healthcare workforce is an essential strategy for promoting effective pain practice. This study aims to evaluate the pain management module training courses for newly graduated doctors to address the knowledge gap between specialist care and primary care physicians. This was an observational study of an evaluation of a pain education project focused on neuropathic pain management core competency was provided. Multimodal teaching approaches such as didactic teaching and vignettes of cases discussion, video teaching, and learning module. A pretest survey was carried out to assess the baseline knowledge of the participants. Completion of the post-test and participant experience questionnaire were collected. Comparison of the pre-and post-test scores for all participants was undertaken using the Wilcoxon signed-ranked test with effect size calculated. The participant's experience questionnaire scores were analyzed descriptively to produce mean and standard deviations from each question. A total of 274 participants completed all of the course sections from the average of 350 eligible participants. Of 274 participants, more than half were female (64.96%), with more than half participants being General Practitioner (54.38%) followed by a neurologist (35.04%). For all sessions, a Wilcoxon signed-rank test outlined that differences between all pre-and post-test scores were significant (P < .001). There was a marked improvement in the post-test as evidenced by statistically significant increases in mean scores differences. We developed an educational training courses for physicians to address the limitation in existing medical undergraduate training of neuropathic pain management. The training led to improvement in participant's knowledge and skills with positive outcomes.

Does Trastuzumab Offer Good Value for Money for Breast Cancer Patients with Metastasis in Indonesia?

OBJECTIVE: Breast cancer is the most common cancer in Indonesia, with Indonesia's breast cancer mortality rate being the highest among Southeast Asian countries. This study aims to evaluate the cost-effectiveness and budget impacts of adding trastuzumab to chemotherapy versus chemotherapy alone for HER2-positive breast cancer patients in Indonesia. METHODS: We performed a Markov model-based economic evaluation to assess cost-effectiveness, cost-utility, and budget impact. Utility data, direct medical costs, and indirect costs were obtained primarily from interviewing patients. Clinical effectiveness data, on the other hand, were obtained from systematic reviews and real-world data and represented through progression free survival, overall survival, and quality-adjusted life years (QALYs). RESULT: From a healthcare provider's perspective, the total costs for the combined group were USD 14,516, while chemotherapy alone cost USD 7,489. While the cost-effectiveness analysis showed that the combination group had a higher total cost by USD 7,027, PFS was longer in the chemotherapy alone group, with a difference of 2.2 months. The ICER was USD 17,307 for every QALY gained. The total cost of adding trastuzumab over a 5-year period was USD 589 million. CONCLUSION: In conclusion, this economic evaluation suggests that the addition of trastuzumab to standard chemotherapy is not cost-effective in terms of PFS and OS compared with chemotherapy alone.
.

Foster Kennedy syndrome caused by tuberculous brain abscess: A case report.

BACKGROUND: A tuberculous brain abscess is an unusual form of central nervous system tuberculosis, whereas Foster Kennedy syndrome is a rare condition characterized by ipsilateral optic atrophy, contralateral papilloedema, and ipsilateral anosmia. Foster Kennedy Syndrome and tuberculous brain abscess both are rare conditions with limited study. We report the first case of Foster Kennedy syndrome associated with tuberculous brain abscess. CASE PRESENTATION: A 32 years old male presented with severe headache, memory impairment, speech difficulty, a slight right-side weakness, and vision impairment for eight weeks. The symptoms began with a low-grade fever, a dry cough, and a loss of appetite, which intensified over time. The patient was generally wasted and drowsy. Physical examination showed right-sided hemiparesis. An enhanced lesion in the left frontal lobe was seen on a plain computed tomography scan accompanied by perifocal edema. An open craniectomy was performed, and antituberculous therapy was begun immediately. The disability had significantly improved in a month. CONCLUSION: In patients with Foster Kennedy syndrome, a tuberculous brain abscess should be considered. Patients who have been diagnosed must undergo surgical surgery as well as antituberculous therapy to recover fully.

Ischemic Stroke following COVID-19 in a Patient without Comorbidities.

BACKGROUND: Stroke is a rare complication of COVID-19. Post-COVID-19 stroke occurs mainly in older patients who have preexisting vascular risk factors. Most strokes are possibly related to hypercoagulability associated with COVID-19 where elevated D-dimer levels were the most common finding. In this case, post-COVID-19 ischemic stroke occurred in a relatively young patient without preexisting cerebrovascular risk factors which were rarely reported before. Case Presentation. A 40-year-old male presented lack of concentration, sluggish mind, and forgetfulness. The patient has a positive COVID-19 history 5 weeks ago. The noncontrast MSCT scan confirmed multifocal lacunar cerebral infarction on the left lateral ventricle. Laboratory tests showed an increase in D-dimer of 1.22 g/ml. CONCLUSION: In COVID-19 patients without comorbidities, ischemic stroke should be considered.

The Benefits of Add-on Therapy of Vitamin D 5000 IU to the Vitamin D Levels and Symptoms in Diabetic Neuropathy Patients: A Randomized Clinical Trial.

BACKGROUND: Previous studies have demonstrated a significant relationship between vitamin D deficiency and the development of diabetic peripheral neuropathy (DPN). However, current studies are limited regarding the potential therapeutic benefits of vitamin D therapy in these patients. OBJECTIVE: This study aimed to assess the effect of oral vitamin D supplementation in patients with diabetic peripheral neuropathy in addition to standard treatment. METHODS: This study was a controlled, open-label, randomized clinical trial with an active comparator randomly allocated with a 1:1 ratio. The experimental group received an add-on oral vitamin D 5000 IU once daily and standard treatment (pregabalin, gabapentin, or amitriptyline) over eight weeks. The control group received standard treatment alone. The measured outcomes were the change in the score of the visual analog scale (VAS), numerical rating scale (NRS), and brief pain inventory (BPI). Vitamin D levels were also measured before and after the trial. RESULTS: Data from 68 subjects with DPN was collected and analyzed. Most of them (60.3%) were female, aged 64.96 ± 8.3 years. After eight weeks of treatment, the experimental group showed a more significant reduction of mean VAS (-3.34 ± 2.03 vs -2.37 ± 2.2, p=0.044) and burning pain (1.76 ± 7.16 vs 6.18 ± 13.93, p=0.046) scores compared to controls. Mood also improves better in the experimental group (88.2% vs 70.6%, p=0.031). At the end of the study, vitamin D levels were also improved more significantly in the experimental group (40.02 ± 15.33 ng/mL vs 18.73 ± 6.88 ng/mL; p<0.001) with greater changes from the baseline to week 8 (+24.14±13.68 ng/mL vs +3.10±4.20 ng/mL; p<0.001) compared to control group. The intervention group showed a negative correlation between vitamin D level and VAS score (r = -0.403, P = 0.018). There were no adverse events recorded in this study. CONCLUSION: The addition of oral vitamin D 5000 IU to standard treatment significantly improves pain, mood, and vitamin D levels more effectively than standard treatment alone in patients with diabetic neuropathy. TRIAL REGISTRATION: ClinicalTrials.gov.no NCT04689958.

Encephalitis due to miliary tuberculosis in a patient with human immunodeficiency virus: A case report.

BACKGROUND: Miliary tuberculosis (TB) is a form of extrapulmonary tuberculosis due to hematogenous dissemination and occurs more frequently in immunocompromised patients. Clinical manifestations are non-specific and varied with the related organ, including central nervous system involvement. We report the first case of encephalitis associated with miliary TB in human immunodeficiency virus (HIV)-the infected patient. CASE PRESENTATION: A 39-year-old male presented with severe headache, numbness in the left side of the body, and partial seizure for two weeks. Previously, the patient complaining of several weeks of cough with generalized weakness. Physical examination showed progressive left-sided weakness and numbness. Chest radiograph showed uniform-sized small nodules randomly distributed diffusely throughout the lungs. Plain computer tomography (CT) brain imaging showed hypodensity in the right parietal region. Laboratory findings showed positive for the HIV antibody test, CD4 counts were 84 cells/µL and acid-fast bacilli from sputum. He was administered empirical anti-TB treatment and was discharged without any complications on day 10. CONCLUSION: This is a rare cause of encephalitis due to miliary TB infection in HIV patients. Even though central nervous system involvement is rare in miliary TB infection, physicians should be aware of atypical features of the disease and comorbidity that may predispose this infection.

Interleukin-6 (IL-6) inhibitors as therapeutic agents for coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis.

INTRODUCTION: Preliminary studies showed that coronavirus disease 2019 (COVID-19) disrupts body immune system, including dysregulation of cytokine interleukin-6 (IL-6). IL-6 inhibitors agents have been used as treatment options for COVID-19, yet their benefit as therapeutic agents remains unclear. OBJECTIVE: We performed a systematic review and meta-analysis to synthesize the available evidence on the potential therapeutic effect of IL-6 inhibitor agents for the treatment of COVID-19. METHODS: Two authors initially screened and reviewed the relevant studies from available databases. The data extracted will be tabulated and analyzed for the outcomes. The primary outcome was mortality. Secondary outcomes included discharge from the hospital, length of stay, and requirement for mechanical ventilation. The quality of each study was assessed using OCEBM ratings. RESULTS: We reviewed 18 studies with a total of 3303 subjects. Tocilizumab was the most commonly used in the studies (15 studies). Meta-analysis of included studies revealed significant reduction in mortality with tocilizumab and sarilumab (RR = 0.61, 95% CI 0.49-0.76). Other outcomes including hospital discharge (RR = 1.04, 95% CI 0.86-1.24), length of stay (mean difference -1.96 days, 95% CI -4.24 to 0.33) or requirement for mechanical ventilation (RR = 0.68, 95% CI 0.32-1.45) revealed no differences of IL-6 inhibitor agents compared to controls. CONCLUSIONS: Available evidence suggests that IL-6 inhibitor agents reduce the risk of mortality in COVID-19, especially in severe conditions. Further well-designed trials are needed for assessing its efficacy and safety for COVID-19.

Effect of DLBS1033 on Functional Outcomes for Patients with Acute Ischemic Stroke: A Randomized Controlled Trial.

BACKGROUND: There are still some unmet needs for stroke management and safety. DLBS1033 is a protein fraction extracted from the earthworm Lumbricus rubellus that has shown fibrinolytic and fibrinogenolytic activities, reduces blood viscosity, and inhibits platelet aggregation that it can be considered an add-on therapy and potential medical breakthrough in acute ischemic stroke management. OBJECTIVE: This study is aimed at measuring the benefit of DLBS1033 in acute ischemic stroke management. METHODS: This was a randomized, open-label trial at a referral stroke center from November 2019 to December 2020. Subjects who met the inclusion criteria were randomly divided into a control group and an experimental group. The control group received standard therapy consisting of aspirin 100 mg once daily, atorvastatin 20 mg once daily, and vitamin B12 100 mg three times daily. The experimental group received standard therapy and DLBS1033 three times daily. The functional outcomes were measured using the National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI), and modified Rankin Scale (mRS) at baseline, hospital discharge, and day 30. RESULTS: Collected data from 180 subjects was analyzed. The NIHSS scores' improvements were significantly greater in the experimental group compared to the control group at both hospital discharge (-5.57 ± 2.16 vs. -3.64 ± 2.65; p < 0.001) and day 30 (-6.62 ± 2.64 vs. -5.14 ± 2.41; p = 0.001). Compared with the control group, the improvements in the BI scores were significantly better in the experimental group, at both hospital discharge (10.69 ± 5.36 vs. 6.64 ± 5.04; p < 0.001) and day 30 (10.9 ± 8.19 vs. 8.56 ± 7.45; p = 0.003). The distribution of mRS scores was improved in both groups during 30 days of follow-up and was more favorable in the experimental group. In both groups, a favorable outcome (mRS < 2) was achieved better at day 30 (86.7% vs. 80%; p = 0.302) than at baseline (0% vs. 6.7%; p = 0.028) and at hospital discharge (58.9% vs. 43.3%; p = 0.085). There was no clinically significant adverse event related to the study product. CONCLUSIONS: DLBS1033 in addition to the standard care was more effective in improving functional status compared to standard care alone in acute ischemic stroke patients with a similar safety profile.

Vitamin D deficiency among patients with COVID-19: case series and recent literature review.

BACKGROUND: The world is now challenging the pandemic of COVID-19 infection. This is the third and most extensive pandemic. Previous studies showed the plausibility of vitamin D prophylaxis and therapy for COVID-19, particularly in settings where hypovitaminosis D is frequent. Recent study from Indonesian showed that the prevalence of vitamin D deficiency was 23.0%. The examination of vitamin D status is not a routine in the Indonesian clinical setting. METHODS: This study is a case series from confirmed cases of COVID-19 in Bethesda Hospital Yogyakarta Indonesia. The data of clinical symptoms, signs and laboratory examinations were obtained from the electronic medical records. The vitamin D status was measured by Enzyme-Linked Fluorescent Assay (ELFA) method. We searched PubMed and Google Scholar for studies that included terms for Vitamin D and COVID-19. RESULTS: The data were obtained from 10 participants consisting of 50% male and 50% female. The mean age was 49.6 years. The prevalence of vitamin D deficiency in this study was 90% (vitamin D levels < 20 ng/mL) and 10% of insufficiency (vitamin D levels < 30 ng/mL). Patients in this study had various symptoms such as fatigue (60%), fever (50%), dry cough (40%), non-specific headache (10%), and diarrhea (10%); have no symptoms (20%); and also had the various chronic diseases as comorbidity such as hypertension (40%), diabetes (10%), COPD (10%), and post stroke (10%). CONCLUSIONS: All of the COVID-19 patients in this study had hypovitaminosis D. The prevalence of vitamin D deficiency in this case series is 90% and only 1 patient (10%) had vitamin D insufficiency. There are many health benefits of vitamin D and very few adverse effects. Randomized controlled trials need to determine and evaluate this recommendation in preventing or treating COVID-19. Clinicians should continue to treat people with vitamin D deficiency especially in managing COVID-19 patients.

Effects of Eperisone Hydrochloride and Non-Steroid Anti-Inflammatory Drugs (NSAIDs) for Acute Non-Specific Back Pain with Muscle Spasm: A Prospective, Open-Label Study.

BACKGROUND: Low back pain (LBP) occurs as a common condition and may harm the patient's quality-of-life. Non-steroid anti-inflammatory drugs (NSAIDs) and eperisone form a drug regiment that has been reported as effective in improving low back pain, yet the evidence for its efficacy and safety is lacking. OBJECTIVE: The aim of this study was to evaluate the effect of eperisone hydrochloride and ibuprofen compared with ibuprofen alone in reducing symptoms of patients with acute non-specific back pain with a muscle spasm. METHODS: This was an open-label, prospective study involving 100 subjects with symptoms of back pain and muscle spasm. Eligible participants were randomly allocated to an experimental group (54 patients) and a control group (46 patients). The experimental group received eperisone 50 mg three times daily + ibuprofen 400 mg twice daily, and the control group received ibuprofen 400 mg twice daily over a 4-week duration. The primary outcomes were measured with the visual analog scale (VAS), and finger-to-floor (FTF) distance at baseline, week 2, and week 4. RESULTS: After 4 weeks of follow-up, results from 59 subjects were collected. In both groups, VAS and FTF were decreased compared to baseline. Clinically significant pain reduction (>50% than baseline) was observed to be higher in the experimental group compared with the control group in the fourth week (72.4% vs 46.7%, P<0.05). At the end of the study, pain reduction in the experimental group was more significant compared to the control group (28.13±24.72 vs 34.42±28.47) and participants mobility (FTF distance <10 cm) improved in both groups, especially in the experimental group (75.9% vs 70%). There was no difference in adverse events between groups (P>0.05). CONCLUSION: The combination of eperisone hydrochloride and ibuprofen effectively reduces pain and improves functional outcomes over ibuprofen alone with a similar safety profile in these patients with acute non-specific back pain with muscle spasm.

Neurologic Characteristics in Coronavirus Disease 2019 (COVID-19): A Systematic Review and Meta-Analysis.

Importance: Coronavirus disease 2019 (COVID-19) is a newly emerging infectious disease that has caused a global pandemic. The presenting symptoms are mainly respiratory symptom, yet studies have reported nervous system involvement in the disease. A systematic review and meta-analysis of these studies are required to understanding the neurologic characteristic of the disease and help physicians with early diagnosis and management. Objective: To conduct a systematic review and meta-analysis on the neurologic characteristics in patients with COVID-19. Evidence Review: Authors conducted a literature search through PubMed from January 1st, 2020 to April 8th, 2020. Furthermore, the authors added additional sources by reviewing related references. Studies presenting the neurologic features of COVID-19 patients in their data were included. Case reports and case series were also included in this review. The quality of the studies was assessed based on the Oxford Center for Evidence-Based Medicine guidelines. Selected studies were included in the meta-analysis of proportion and the heterogeneity test. Finding: From 280 identified studies, 33 were eligible, with 7,559 participants included. Most of the included studies were from China (29 [88%]). Muscle injury or myalgia was the most common (19.2%, 95%CI 15.4-23.2%) neurologic symptom of COVID-19, followed by headache (10.9%, 95%CI 8.62-13.51%); dizziness (8.7%, 95%CI 5.02-13.43%); nausea with or without vomiting (4.6%, 95%CI 3.17-6.27%); concurrent cerebrovascular disease (4.4%, 95%CI 1.92-7.91%); and impaired consciousness (3.8%, 95%CI 0.16-12.04%). Underlying cerebrovascular disease was found in 8.5% (95%CI 4.5-13.5%) of the studies. Conclusion: Neurologic findings vary from non-specific to specific symptoms in COVID-19 patients. Some severe symptoms or diseases can present in the later stage of the disease. Physicians should be aware of the presence of neurologic signs and symptoms as a chief complaint of COVID-19, in order to improve management and prevent a worsening outcome of the patients.